Guest post by John Olajide, president and CEO, Axxess.
The home health delivery model has become more prevalent in recent years as a cost-effective, patient-preferred alternative to traditional hospital and skilled nursing settings. Approximately 12 million U.S. individuals receive care from more than 33,000 agencies for acute illness, long-term health conditions, permanent disability, or terminal illness — according to a survey by the National Association for Home Care & Hospice (NAHCH).
Demand for home health services is seeing an increase as more baby boomers turn 65 daily and choose to receive their health care services at home. Recent surveys of older adults are showing a preference to receive healthcare in the dignity and comfort of their homes. As an example, surveys by the American Association of Retired Persons (AARP) consistently show that over 80 percent of older adults want to remain in their homes and communities throughout their lives. Several surveys show the same trend in the wider patient populations; and technology innovations are making it possible to deliver quality healthcare services to patients at home.
While the increased awareness in and recent growth of the home healthcare sector is promising for home health agencies, critical to their success is the adoption and integration of the right cloud-based technology to increase operational efficiency, ensure compliance with stringent regulatory requirements and improve patient outcomes.
Technology can also assist in preventing home healthcare fraud. While fraud can occur in all sectors of healthcare, home health is unique in that the caregiver visits the patient in the home. A common example of fraud in home health is when a caregiver submits documentation for visits that were not made and the home health organization, in turn, submits claims to insurance providers for such services without obtaining proof that such service was actually rendered. Home health agencies would be wise to protect themselves from the possibility of this type of fraudulent activity by a disreputable employee.
It’s called healthcare for a reason. Technology is a powerful tool, but people are the solution. The Twine Health Collaborative Care Platform allows for the co-creation and tracking of personalized care plans that serve as common ground for continuous collaboration between patients, coaches and their clinicians. Patients get support from their care team, on their terms whenever, wherever they are: so they reach their health goals faster and focus on living.
Healthcare has lost its way. In recent years the “care” has fallen by the wayside — victim of flawed automation efforts, perverse payment models and the constant pressure to reduce costs. Technology is a powerful tool. However, if not used properly it’s impersonal and the human connections, which are critically important to caregiving, get lost. People are the solution to better healthcare.
People are the most underutilized resource in health. Twine Health changes the game by empowering them to take an active role in their care, learning along the way, and overtime building self-efficacy. Twine Health surfaces patients who need help at just the right time, allowing them to remain effective even as panel sizes grow. Coaches provide the ongoing support and expertise that is key to successful behavioral change. This also allows clinicians the time and focus to practice at the top of their license, interacting directly with patients when challenging medical conditions arise.
Elevator Pitch
The Twine Collaborative Care Platform is a new class of digital health technology that helps patients build self-efficacy via continuous support from coaches and their clinicians. Spun out of research performed at the MIT Media Lab, and proven cost effective via clinical trials and commercial pilots, Twine delivers results that cannot be ignored – 90 percent of patients reach their health goals (e.g., blood pressure < 140/90) within 3 months at 1/3 the cost of the standard of care.
Founder’s Story
John O Moore MD, PhD
John Moore, MD, PhD, is the co-founder and CEO of Twine Health. Moore’s passion for a better healthcare system started during his medical training where he was frustrated to learn that the best diagnostic and treatment capabilities did not result in healthier and engaged people. To be successful, Moore realized patients had to be in control of their own care, but also recognized the clear need for expert support. Moore came up with the idea for Twine Health during six years at the MIT Media Lab where he studied the healthcare delivery model and created a revolutionary approach to care: technology-supported apprenticeship. Bringing together advances in health psychology, learning science and human-computer interaction, Twine is designed to become the primary tool for teamwork between patients and clinicians. Before attending medical school, Moore received a BS in Biomedical engineering, and was a Fulbright Scholar.
Marketing/Promotion Strategy
Patients, coaches and clinicians are looking for a better way to provide and receive care – a way to make health care healthier. Twine Health provides clinicians, and the health organizations (HCOs) they work for, an effective and scalable chronic care platform that improves outcomes, reduces costs and increases patient and clinician satisfaction. The results speak for themselves:
Various forms of payment reform are in play throughout US healthcare today, and with good reason as we search for the right combination of incentives, alignment and engagement that produce systemically better health outcomes at lower overall cost.
As an example, providers are paying much more attention to the small percentage of patients with the highest costs, including patients with chronic conditions. As a result, they are identifying these patients, establishing care plans and engaging care coordinators and patients to improve outcomes. Less attention, however, is being focused on the powerful capability to better connect, communicate and coordinate care among the multiple providers that care for a patient. This caliber of care coordination has the potential to improve outcomes across the entire patient population and is rooted in results that suggest a coordinated network of providers, each capable of high quality and cost effective care, with appropriate information about the patient available to them, can deliver improved outcomes across large patient populations.
Patient populations may be systemically managed under various forms of accountable care, commercial shared savings, Medicare Advantage and full risk – or managed by episodes of care, bundled payments, etc. The shift from fee-for-service to “fee-for-value” incentivizes preventive care, best practice care, and high-value delivery of care and it puts a premium on the ability to coordinate care.
Therein lies a very significant challenge: The collective group of providers that interact with a large patient population are invariably part of different organizations, with different technology platforms or no platform at all and are dependent upon fax machines, phones, and paper to exchange documents and communicate. The provider groups also possess differing incentives: the “at-risk” provider attempts to influence improved health and financial outcomes while other providers may still be receiving fee-for-service payments.
Reconciling these challenges and harnessing the power of care coordination is now possible via referral coordination. One of the most powerful mechanisms for coordinating care are the hundreds of thousands of patient referrals made every day between various providers, with Primary Care Providers (PCP) being the largest initiator of consulting and diagnostic referrals on behalf of their patients. Providers need to communicate with each other when they are treating the same patient, and these patient transitions between providers represent a significant opportunity to realize high value care.
The referral itself is equivalent to a PCP or patient making a decision on which provider to “hire” to provide the needed care. This referral decision and the coordination of the referral are critical to the delivery of better health at lower cost, but improving the overall referral process requires key elements to be implemented consistently:
Guest post by Steven Chau, CTO and co-founder, Doctor Quickly.
Healthcare is one of the last industries to be disrupted by technology. Although unprecedented levels of biomedical knowledge, surgical procedures, and condition management have been amassed, we are not using them to their potential to create the tools to improve healthcare experiences. A balance of privacy and policy regulations with technology is the key to creating a secure yet efficient healthcare system.
The State of Healthcare
A staggering portion of healthcare costs are wasted. According to the Institute of Medicine (IOM), $765 billion or 30 percent of the 2009 total U.S. healthcare spending was wasted. Key areas that were tracked include unnecessary services, services inefficiently delivered, prices that are too high, excess administrative costs, missed prevention opportunities and medical fraud.
Key findings:
Overused services, defensive medicine and higher-cost services total $210 billion in excess cost;
Medical errors, care fragmentation and preventable complications total $130 billion in excess cost;
Duplicative costs to administer insurance and insurances’ administrative inefficiencies drive $190 billion in excess cost;
Product prices beyond competitive levels total $105 billion in excess cost;
Missed prevention opportunities like primary, secondary and tertiary prevention total $55 billion in excess cost;
Fraudulent claims total $75 billion in excess cost.
Additionally, there will not be enough physicians in the next few years to meet the growing demand. The Association of American Medical Colleges (AAMC) projects a shortage of 62,000 physicians by 2015. This shortage is expected to increase to 91,000 by 2020. This physician deficit is due to an aging Boomer Baby population, the insuring millions of new patients through the Affordable Card Act, and the retiring of a large number of doctors in the coming decade.
Technology can curb inefficient health management, increase knowledge sharing, and improve access to a shrinking physician pool. However, proper precautions must be taken to safeguard patient information privacy while empowering healthcare providers to provide more efficient care.
HIPAA
Healthcare technology is largely regulated by the Health Insurance Portability and Accountability Act (HIPAA). It was created in 1996 to protect the privacy of electronic patient data, known as protected health information (PHI) and to restrict access to PHI. Predating the iPhone by 10 years, the HIPAA rules were strengthened in 2013 to increase rigor on de-identifying PHI, to broaden HIPAA’s reach to include all entities that touch PHI directly and indirectly, and to notify affected parties if a PHI breach has occurred.
What do Disney, Apple, Southwest Airlines, Mayo Clinic, USAA, Amazon, Pandora, and Kaiser Permanente have in common? They all sell the same thing.
Whoa! That’s crazy talk. What’s that you say?
Yes, each of these organizations knowingly and deliberately differentiates and competes on customer experience. In fact, each one delivers the best customer experience in its respective industry, as measured by Net Promoter Scores.* Whether delivering immersive entertainment, personalized radio or healthcare, these companies make an emotional connection and engage their customers in extraordinary ways.
Within healthcare the importance of the patient experience cannot be overstated. Our personal health and well-being is synonymous with happiness and is manifest in our personal experience. For many of us, being sick, in pain or in fear for our life (or the life of a loved one) tends to heighten our perceptions and amplify every experience. It’s during such times when a kind word can seem like a grand benevolence, and the slightest oversight feels like a cruel insult. As such, providers should invest as much energy in delivering the best possible customer experience as they do in delivering safe and effective treatment.
Patient satisfaction is not patient experience
The Beryl Institute defines patient experience as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” Unfortunately, the standard method for measuring patient perceptions about healthcare is a collection of survey questions. Don’t get me wrong; we need a consistent method for assessing patient perceptions to make apples-to-apples comparisons between organizations. The Consumer Assessment of Healthcare Providers and Systems (CAHPS**) survey offers healthcare consumers and financers just that – information by which to make such comparisons. However, the subjective survey data alone is insufficient for providers to fully comprehend and then systematically improve patient experiences.
I won’t belabor the difference between patient satisfaction and patient experience here, but I will draw your attention to Fred Lee’s work on this subject. Lee aptly compares Disney with American hospitals in his best-selling book If Disney Ran Your Hospital: 9 ½ Things You Would Do Differently. I strongly encourage you to invest 17 minutes watching his funny and exceptional TEDx talk on the fundamental difference between patient satisfaction and patient experience.
Amazing Charts, a provider of electronic health records and practice management solutions, issued its healthcare predictions for 2015. Some interesting predictions here I thought you might find worthwhile. Concierge medicine, which I’ve said for some time is going to have a lasting impact, especially in the era of the Affordable Care Act, made the list.
Patient engagement, and consumerism of healthcare– somewhat of a slam dunk — appears here, too. I believe we’ve get some clarification on what that movement means this year. Amazing Charts agrees.
Also, wearables (oh, wearables, will you become more than a fad?) makes this list, and telehealth is here, too; I think we’ve finally reached the saturation point of telemedicine. This year should show strong results that I hope will validate its role at the point of care. We’ll finally get to see if payers get the message.
Here’s the full list of healthcare predictions for 2015 from Amazing Charts:
Membership Medicine Comes on Strong: The patient membership approach to medicine will grow in all forms, including value-based Direct Primary Care (DPC), high-end concierge medicine and primary care services contracted directly by employers. Market-driven medicine, fueled by changes occurring in healthcare today, such as inexpensive health plans with very high deductibles, will continue to encourage consumers to explore more cost-effective alternatives for primary care.
Patients Help Define the Experience: The patient, in partnership with the provider, will help define the care experience going forward. This trend will be powered by technologies that enhance face-to-face interaction in the exam room. One example is the projection of an EHR onto a large display screen to facilitate information sharing between provider and patient. This in turn will help reduce errors and misdiagnosis, as well as motivate patients to take a renewed interest in their own healthcare and treatment options.
EHRs Get Personalized: The EHR market will further mature and become customizable for individual patient needs and treatment plans. Intuitive data analytics will play a critical role here, helping clinicians measure, assess and manage their specific patient populations to better define specific gaps in clinical care and introduce the latest evidenced-based treatment procedures or diagnostic techniques.
Guest post by Michael Simpson is the CEO of Caradigm.
It’s been five years since the HITECH Act was enacted as part of ARRA, and while there’s still a lot of debate about the technical details, rules and timelines involved with electronic health record (EHR) adoption and meaningful use, it’s clear that the focus on EHRs – and incenting hospitals and professionals to use EHRs in a meaningful way – represents a critical, foundational step in transforming health care in this country.
After all, meaningful use targets the right goals – goals that every hospital, health system and healthcare professional supports, including improved quality, safety and efficiency of care; reduced disparities; more engaged patients and families as core members of the care team; improved care coordination and population health; and more secure patient health information.
More important, the stages of meaningful use drive a set of progressively more advanced capabilities that are fundamental to achieving those goals. Digitizing data was the first critical step, and the good news is that according to a recent HHS press release, about 60 percent of all hospitals have adopted an advanced EHR, leaving the paper world behind. The next steps are sharing that data – securely – among providers and patients, reporting on quality to understand and improve it, using clinical decision support at the point of care, and many other capabilities critical to transforming care and outcomes. If providers and professionals meet meaningful use requirements, we should see more transparency, greater efficiency, reduced waste and more healthy people in our communities over time.
Stage 2 Challenges
It’s a long and challenging journey, and while hospitals and health systems are making good progress against Stage 1 requirements, very few are prepared for Stage 2. In fact, according to survey data from the American Hospital Association, fewer than 6 percent of hospitals have met the criteria for Stage 2, and only 10 percent have met the requirement for patients to be able to view, download and transmit their health information online.
Why are providers getting stuck as they try to move to Stage 2? Because as the requirements become more demanding – e.g., using clinical decision support, generating patient lists, protecting patient health information, engaging patients – these organizations need a new set of technology capabilities to meet those requirements. These capabilities leverage and extend the functionality and benefits of the EHR.
Moreover, to reach the ultimate goals targeted by Meaningful Use — improved quality, efficiency, outcomes and population health — providers will need to aim even higher than meeting the requirements of meaningful use stages, strategically using data from EHRs and myriad other systems across the care continuum to enable a new level of capabilities.
Guest post by Nilesh Chandra and Nick Mathisen, healthcare experts at PA Consulting.
Nilesh Chandra
Healthcare as an industry is undergoing rapid, fundamental changes brought about by reform. The Affordable Care Act of 2010 turned the incentive system upside down for healthcare providers, moving them from fee-for-service payments to Accountable Care Models. Providers who previously made money by separately charging for each procedure and bore little financial risk for patient health, now get paid a single bundled amount for providing care for a group of people, with incentives to reduce the total cost of care and share in those savings. Taking a cue from Medicare and Medicaid, private health insurers are increasingly adopting similar payment models.
The challenges today
Nick Mathisen
Doctors and nurses who had the responsibility to help sick people get better, are now expected to keep people healthy. Hospital administrators who were measured on financial metrics like bed utilization are now expected to keep people out of hospitals. Traditional healthcare involved dealing with sick people who came in to hospitals and clinics. Tomorrow, healthcare will be about proactively engaging with healthy people and encouraging them to adopt behaviors that keep them healthy. This will involve outreach and engagement in entirely new ways that the modern healthcare industry has not done before.
The future of healthcare
The future of healthcare is outside the boundaries of what our modern healthcare industry knows how to do.
Think about it. Many industries are facing disruptive innovation where the future of the industry is completely different from what has been the norm. For example, the PC industry with the rapid shift to tablets, or retail with the increasing move to online channels. However, both of those industries have always been subject to rapid innovation and players have learned to evolve rapidly. The transformation in healthcare is more profound because it is larger in scale and it has a much greater impact on people’s lives.
So what does the future of healthcare involve and how can technology help? There are three key elements that the healthcare industry has to learn to be more efficient and proactive:
Caring for the chronically sick more efficiently with wearables
The rate of diabetes, heart conditions, obesity and other chronic conditions are projected to continually rise. The chronically ill consume a large proportion of healthcare, therefore any efficiency gained in providing care for them translates into significant savings in the overall health system. A recent study from Robert Wood Johnson University hospital found that 80 percent of all heart-attacks could have been prevented by simple changes in lifestyle. Changes in lifestyle will have a similar positive impact on other chronic conditions as well.
